Learning Outcome

1. Recall the risk factors for osteoporosis.
2. Identify appropriate nursing diagnoses for patients with osteoporosis.
3. Summarize the treatment of osteoporosis.
4. Discuss the nursing role in the management of a patient with osteoporosis

Introduction

Osteoporosis is a chronic condition characterized by excessive bone loss [1][2]. Osteoporosis may be triggered by various etiologies. For example, primary osteoporosis occurs with aging, whereas secondary osteoporosis occurs when the condition is caused by another disease or medical treatment. Complications of osteoporosis can include fractures—especially of the hip and spine. The purpose of this article is to review nursing diagnoses, causes, risk factors, assessment, evaluation, medical management, nursing management, and other aspects of importance to nurses.

Nursing Diagnosis

Some nursing diagnoses which might be appropriate for patients with a medical diagnosis of osteoporosis include impaired mobility if a limited range of motion is present, deficient knowledge, imbalanced nutrition, the risk for falls, the risk for injury if substantial bone loss is presently increasing the risk of fractures, and acute pain if fractures occur due to bone loss.

Causes

Osteoporosis involves the process of osteoblast and osteoclast function. In primary osteoporosis, osteoblast activity slows while osteoclast activity.[1] Normally, these two functions are balanced but become imbalanced with aging due to changes in hormones. Secondary osteoporosis can occur due to prescribed glucocorticoids.

Risk Factors

Multiple factors increase the risk of developing osteoporosis. Risk factors for osteoporosis include belonging to a certain ethnic group (Caucasian, Asian), increased age, having a small body frame, having a family history of osteoporosis, gender (with females at higher risk than males), smoking, and alcohol use.

Assessment

A patient’s history will include an assessment for the presence of risk factors for osteoporosis, such as a family history of osteoporosis, ethnicity, increased age, smoking history, and alcohol consumption. A physical assessment will involve assessing the patient’s body for a small frame and any late changes such as height loss and kyphosis.

Evaluation

Screening for osteoporosis is recommended for women beginning at age 65 years of age and for men at 70 years of age. Patients with risk factors for osteoporosis should be screened at earlier ages. Bone density testing is commonly used to diagnose osteoporosis. Evaluating the patient's fracture risk is also important.[3]

Medical Management

A healthy diet and weight-bearing exercise are important in the prevention and treatment of osteoporosis. Medical management of osteoporosis includes prescribed medication for the prevention or treatment of osteoporosis. Bisphosphonates are a major class of medications used to prevent or treat osteoporosis; alendronate and risedronate are examples. Monoclonal antibody medications are prescribed to increase bone mineral density.[4][5] Hormone-related therapy is another medication therapy for osteoporosis. One example is calcitonin traditionally prescribed to post-menopausal patients with osteoporosis; newer research is exploring the outcomes of the various newer medication therapies among post-menopausal patients.[6] Additionally, new therapies are emerging, and prescribing medications to maximize bone preservation is key.[2][7]

With fractures being a major complication of osteoporosis, surgical management might be necessary.[8]

Nursing Management

Nursing care of patients with osteoporosis includes assessing the patient’s physical functioning and ability to complete self-care. Nursing management should include encouraging weight-bearing activity, assisting the patient with self-care as needed, and providing ambulatory aid for patients who have an unsteady gait.[9][10] In addition, the nurse is responsible for providing patient education relating to healthy dietary intake rich in calcium and vitamin D, smoking cessation, limited alcohol intake, and the prescribed medications since patients’ lack of adherence to the medication regimen is not uncommon.[11]

When To Seek Help

Patients with osteoporosis have an increased risk of fractures. When fractures occur, patients should seek medical attention. Signs and symptoms might include sudden limitation in movement and increased pain with movement. If the patient reports these complaints—especially after a fall—consult the healthcare provider.

Outcome Identification

An expected outcome for patients with osteoporosis is that the patient maintains ranges of motion in their joints. Patient t-scores and z-scores can also help monitor outcomes and the effectiveness of interventions.

Monitoring

Monitoring for patient compliance with the plan of care and for fractures as a complication of osteoporosis is important. 

Coordination of Care

Collaboration among healthcare team members can prove beneficial for patients with osteoporosis. Besides the healthcare providers and nurses, other interdisciplinary team members who might be involved in the care plan for patients with osteoporosis include pharmacists, endocrinologists, registered dieticians, and physical or occupational therapists. If fractures develop, orthopedic surgeons might also serve on the team. Social workers and case managers can address psychosocial or financial issues along with needs for special equipment.

Health Teaching and Health Promotion

Equipping patients with the proper knowledge to mitigate their risk of developing osteoporosis or the associated complications is critical. Nurses should assess the patient’s knowledge of osteoporosis and provide education regarding dietary intake (such as increasing calcium and vitamin D intake, recognizing foods high in calcium, and limiting sodas or colas, which are usually high in phosphorus), and exercise. While providing patient education, the nurse should also assess any potential barriers such as limited access to healthy foods in the community, limited income, or language barriers. Nurses also are responsible for teaching the importance of regular screenings (such as bone density tests) and healthy lifestyle choices (such as smoking cessation and moderation in alcohol intake).

Risk Management

Ensuring patient safety is of utmost importance. Knowing that fractures are a major risk for patients with osteoporosis, providing patient teaching regarding fracture risk reduction is imperative. This encompasses patient education regarding increased intake of calcium and vitamin D, participating in weight-bearing exercise if not contraindicated, smoking cessation, limiting alcohol intake, and medication regimen compliance. Failure to properly educate patients may result in significant consequences and present liability as well.

Discharge Planning

Review the plan of care and prescribed medication regimen for patients with osteoporosis is essential upon discharge. Additionally, the nurse should provide patient education encompassing health promotion and review when to follow-up with the healthcare provider after discharge.

Evidence-Based Issues

Both lifestyle modification and medication therapy have demonstrated positive outcomes for patients with osteoporosis. Implementing evidence-based nursing care involves providing patient teaching regarding the care plan and promoting optimal patient functioning while decreasing the patient’s risk of injury.

Pearls and Other issues

• Osteoporosis is characterized by bone loss.
• Risk factors for osteoporosis include being White or Asian race, increased age, small-framed, being female, smoking, increased alcohol intake, and family history of osteoporosis.
• The main diagnostic tool for osteoporosis is bone density testing.
• Medical management for osteoporosis involves bisphosphonates.
• Lifestyle modification plays a key role in osteoporosis prevention and treatment.
• Patients should consult with their healthcare provider when experiencing acute pain, which increases with movement.